Anatomic considerations for a modified posterior approach to the scapula.

A modified posterior approach to the scapula was tested on 20 cadavers. The approach also was used in 2 cases with fractures involving the scapular neck and glenoid fossa. The incision is C shaped, with the convexity directed toward the lateral angle of the scapula. The posterior muscle fibers of the deltoid are reflected laterally after detaching them from their origin. The infraspinatus is mobilized without division to expose the posterior surface of the scapular neck and glenoid. Access to the rest of the posterior and the superior surfaces of the glenoid can be achieved by osteotomizing the acromion. The suprascapular neurovascular bundle is identified and protected at an average of 1.4 +/- 0.1 cm from the glenoid rim, where it is adherent to the spinoglenoid angle of the scapula. The circumflex scapular artery is protected at the lateral border of the scapula at an average of 2.8 +/- 0.5 cm from the inferior glenoid margin. The axillary nerve is protected inferior to the teres minor. However, care should be taken not to excessively retract the teres minor because the nerve lies in close proximity to the shoulder joint capsule.